ppe use in healthcare settings

PPE Use in Healthcare PPE Use in Healthcare SettingsSettings

Prof. Elisaveta StikovaProf. Elisaveta Stikova

Personal Protective Equipment Personal Protective Equipment DefinitionDefinition

““specialized clothing or equipment specialized clothing or equipment worn by an employee for protection worn by an employee for protection against infectious materials” against infectious materials” (OSHA)(OSHA)

PPE Use in Healthcare Settings

Hierarchy of Safety and Health Hierarchy of Safety and Health ControlsControls

Training and administrative Training and administrative controlscontrols

Engineering controlsEngineering controls Work practice controlsWork practice controls Personal protective equipmentPersonal protective equipment


Types of PPE Used in Types of PPE Used in Healthcare SettingsHealthcare Settings

Gloves – protect handsGloves – protect hands Gowns/aprons – protect skin and/or clothing Gowns/aprons – protect skin and/or clothing Masks and respirators– protect mouth/nose Masks and respirators– protect mouth/nose

• Respirators – protect respiratory tract from Respirators – protect respiratory tract from airborne infectious agentsairborne infectious agents

Goggles – protect eyesGoggles – protect eyes Face shields – protect face, mouth, nose, and Face shields – protect face, mouth, nose, and

eyeseyes

GlovesGloves

Purpose – patient care, Purpose – patient care, environmental services, otherenvironmental services, other

Glove material – vinyl, latex, Glove material – vinyl, latex, nitrile, othernitrile, other

Sterile or nonsterileSterile or nonsterile Single use or reusableSingle use or reusable

Do’s and Don’ts of Glove UseDo’s and Don’ts of Glove Use

Work from “clean to dirty”Work from “clean to dirty” Limit opportunities for “touch Limit opportunities for “touch

contamination” - protect yourself, contamination” - protect yourself, others, and the environmentothers, and the environment• Don’t touch your face or adjust PPE Don’t touch your face or adjust PPE

with contaminated gloveswith contaminated gloves• Don’t touch environmental surfaces Don’t touch environmental surfaces

except as necessary during patient except as necessary during patient carecare

Do’s and Don’ts of Glove Use Do’s and Don’ts of Glove Use (cont’d)(cont’d)

Change glovesChange gloves• During use if torn and when heavily During use if torn and when heavily

soiled (even during use on the same soiled (even during use on the same patient)patient)

• After use on each patientAfter use on each patient Discard in appropriate receptacleDiscard in appropriate receptacle

• Never wash or reuse disposable glovesNever wash or reuse disposable gloves

Gowns or ApronsGowns or Aprons

Purpose of usePurpose of use Material –Material –

• Natural or man-madeNatural or man-made

• Reusable or disposableReusable or disposable

• Resistance to fluid penetrationResistance to fluid penetration

Clean or sterileClean or sterile

Face ProtectionFace Protection

Masks – protect nose and mouthMasks – protect nose and mouth• Should fully cover nose and mouth Should fully cover nose and mouth

and prevent fluid penetrationand prevent fluid penetration Goggles – protect eyesGoggles – protect eyes

• Should fit snuggly over and around Should fit snuggly over and around eyeseyes

• Personal glasses not a substitute for Personal glasses not a substitute for gogglesgoggles

Face ProtectionFace Protection

Face shields – protect face, nose, Face shields – protect face, nose, mouth, and eyesmouth, and eyes• Should cover forehead, extend below Should cover forehead, extend below

chin and wrap around side of facechin and wrap around side of face

Respiratory ProtectionRespiratory Protection

Purpose – protect from inhalation of Purpose – protect from inhalation of infectious aerosolsinfectious aerosols

PPE types for respiratory protectionPPE types for respiratory protection• Particulate respiratorsParticulate respirators• Half- or full-face elastomeric respiratorsHalf- or full-face elastomeric respirators• Powered air purifying respirators (PAPR)Powered air purifying respirators (PAPR)

Elements of a Respiratory Elements of a Respiratory Protection ProgramProtection Program

Medical evaluationMedical evaluation Fit testingFit testing TrainingTraining Fit checking before useFit checking before use


For additional information on For additional information on respirators….respirators….

http://www.cdc.gov/niosh/npptl/http://www.cdc.gov/niosh/npptl/respirators/ respsars.htmlrespirators/ respsars.html

http://www.cdc.gov/niosh/99-http://www.cdc.gov/niosh/99-143.html143.html

http://www.cdc.gov/niosh/topics/http://www.cdc.gov/niosh/topics/respiratorsrespirators


PPE Use in Healthcare PPE Use in Healthcare Settings:Settings:

How to Safely Don, Use, How to Safely Don, Use, and Remove PPEand Remove PPE

Key Points About PPEKey Points About PPE

Don before contact with the patient, Don before contact with the patient, generally before entering the roomgenerally before entering the room

Use carefully – don’t spread Use carefully – don’t spread contaminationcontamination

Remove and discard carefully, either at Remove and discard carefully, either at the doorway or immediately outside the doorway or immediately outside patient room; remove respirator outside patient room; remove respirator outside roomroom

Immediately perform hand hygieneImmediately perform hand hygiene

Sequence* for Donning PPESequence* for Donning PPE Gown firstGown first Mask or respiratorMask or respirator Goggles or face shieldGoggles or face shield GlovesGloves

How to Don a GownHow to Don a Gown

Select appropriate type and sizeSelect appropriate type and size Opening is in the backOpening is in the back Secure at neck and waistSecure at neck and waist If gown is too small, use two gownsIf gown is too small, use two gowns

• Gown #1 ties in frontGown #1 ties in front

• Gown #2 ties in backGown #2 ties in back

How to Don a MaskHow to Don a Mask Place over nose, mouth and chinPlace over nose, mouth and chin Fit flexible nose piece over nose Fit flexible nose piece over nose

bridgebridge Secure on head with ties or elasticSecure on head with ties or elastic Adjust to fitAdjust to fit

How to Don a Particulate How to Don a Particulate RespiratorRespirator

Select a fit tested respiratorSelect a fit tested respirator Place over nose, mouth and chinPlace over nose, mouth and chin Fit flexible nose piece over nose bridgeFit flexible nose piece over nose bridge Secure on head with elasticSecure on head with elastic Adjust to fitAdjust to fit Perform a fit check – Perform a fit check –

• Inhale – respirator should collapseInhale – respirator should collapse• Exhale – check for leakage around faceExhale – check for leakage around face

How to Don Eye and Face How to Don Eye and Face ProtectionProtection

Position goggles over eyes Position goggles over eyes and secure to the head and secure to the head using the ear pieces or using the ear pieces or headbandheadband

Position face shield over Position face shield over face and secure on brow face and secure on brow with headbandwith headband

Adjust to fit comfortablyAdjust to fit comfortably

How to Don GlovesHow to Don Gloves Don gloves lastDon gloves last Select correct type and sizeSelect correct type and size Insert hands into glovesInsert hands into gloves Extend gloves over isolation gown Extend gloves over isolation gown

cuffscuffs


How to Safely Remove How to Safely Remove PPEPPE

Sequence for Removing PPESequence for Removing PPE GlovesGloves Face shield or gogglesFace shield or goggles GownGown Mask or respiratorMask or respirator


Where to Remove PPEWhere to Remove PPE At doorway, before leaving patient At doorway, before leaving patient

room or in anteroom*room or in anteroom* Remove respirator outside room, Remove respirator outside room,

after door has been closed*after door has been closed*

* Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

How to Remove Gloves (1)How to Remove Gloves (1)

Grasp outside edge Grasp outside edge near wristnear wrist

Peel away from hand, Peel away from hand, turning glove inside-turning glove inside-outout

Hold in opposite Hold in opposite gloved handgloved hand

How to Remove Gloves (2)How to Remove Gloves (2)

Slide ungloved finger Slide ungloved finger under the wrist of the under the wrist of the remaining gloveremaining glove

Peel off from inside, Peel off from inside, creating a bag for creating a bag for both glovesboth gloves

DiscardDiscard

Remove Goggles or Face Remove Goggles or Face ShieldShield

Grasp ear or head Grasp ear or head pieces with pieces with ungloved handsungloved hands

Lift away from faceLift away from face Place in designated Place in designated

receptacle for receptacle for reprocessing or reprocessing or disposaldisposal

Removing Isolation GownRemoving Isolation Gown

Unfasten tiesUnfasten ties Peel gown away from Peel gown away from

neck and shoulderneck and shoulder Turn contaminated Turn contaminated

outside toward the outside toward the insideinside

Fold or roll into a Fold or roll into a bundlebundle

DiscardDiscard

Removing a MaskRemoving a Mask

Untie the bottom, Untie the bottom, then top, tiethen top, tie

Remove from faceRemove from face DiscardDiscard


Removing a Particulate Removing a Particulate RespiratorRespirator

Lift the bottom Lift the bottom elastic over your elastic over your head firsthead first

Then lift off the Then lift off the top elastictop elastic

DiscardDiscard

Hand HygieneHand Hygiene

Perform hand hygiene immediately Perform hand hygiene immediately after removing PPE.after removing PPE.• If hands become visibly contaminated If hands become visibly contaminated

during PPE removal, wash hands before during PPE removal, wash hands before continuing to remove PPEcontinuing to remove PPE

Wash hands with soap and water Wash hands with soap and water or use an alcohol-based hand rubor use an alcohol-based hand rub


When to Use PPEWhen to Use PPE

Standard and Expanded Standard and Expanded Isolation PrecautionsIsolation Precautions

Standard PrecautionsStandard Precautions

Previously called Universal PrecautionsPreviously called Universal Precautions Assumes blood and body fluid of ANY Assumes blood and body fluid of ANY

patient could be infectiouspatient could be infectious Recommends PPE and other infection Recommends PPE and other infection

control practices to prevent control practices to prevent transmission in any healthcare settingtransmission in any healthcare setting

Decisions about PPE use determined by Decisions about PPE use determined by type of clinical interaction with patienttype of clinical interaction with patient


PPE for Standard Precautions PPE for Standard Precautions (1)(1)

GlovesGloves – Use when touching blood, – Use when touching blood, body fluids, secretions, excretions, body fluids, secretions, excretions, contaminated items; for touching contaminated items; for touching mucus membranes and nonintact skinmucus membranes and nonintact skin

GownsGowns – Use during procedures and – Use during procedures and patient care activities when contact of patient care activities when contact of clothing/ exposed skin with blood/body clothing/ exposed skin with blood/body fluids, secretions, or excretions is fluids, secretions, or excretions is anticipatedanticipated


PPE for Standard Precautions PPE for Standard Precautions (2)(2)

Mask and goggles or a face Mask and goggles or a face shieldshield – Use during patient care – Use during patient care activities likely to generate activities likely to generate splashes or sprays of blood, body splashes or sprays of blood, body fluids, secretions, or excretionsfluids, secretions, or excretions


What Type of PPE Would What Type of PPE Would YouYou Wear?Wear?

Giving a bed bath?Giving a bed bath? Suctioning oral Suctioning oral

secretions?secretions? Transporting a Transporting a

patient in a wheel patient in a wheel chair?chair?

Responding to an Responding to an emergency where emergency where blood is spurting?blood is spurting?

Drawing blood from Drawing blood from a vein?a vein?

Cleaning an Cleaning an incontinent patient incontinent patient with diarrhea?with diarrhea?

Irrigating a wound?Irrigating a wound? Taking vital signs?Taking vital signs?


PPE for Expanded PrecautionsPPE for Expanded Precautions Expanded Precautions includeExpanded Precautions include

• Contact PrecautionsContact Precautions

• Droplet PrecautionsDroplet Precautions

• Airborne Infection IsolationAirborne Infection Isolation

Hand HygieneHand Hygiene

Required for Standard and Expanded Required for Standard and Expanded PrecautionsPrecautions

Perform…Perform…• Immediately after removing PPEImmediately after removing PPE

• Between patient contactsBetween patient contacts

Wash hands thoroughly with soap and Wash hands thoroughly with soap and water or use alcohol-based hand rubwater or use alcohol-based hand rub


Final Thoughts:Final Thoughts: PPE is available to protect you PPE is available to protect you

from exposure to infectious agents from exposure to infectious agents in the healthcare workplacein the healthcare workplace

Know what type of PPE is Know what type of PPE is necessary for the duties you necessary for the duties you perform and use it correctlyperform and use it correctly

ppe use in healthcare settings

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